Understanding Hair Fall After Bariatric Surgery: Causes and Solutions

People who undergo bariatric surgery are mostly anxious about their hair health. After undergoing bariatric surgery, some hair loss is common between 3 and 6 months and can last up to 6 to 12 months or more, however, it is almost always temporary.

The reasons for hair loss are not absolutely clear. The probable causes may be age, gender, comorbidities, medications, harmful cosmetics, and genetic factors.

The Hair Growth Cycle

Human hair has a two-phase growth cycle. The Anagen (hair growth) phase and the Telogen (inactive) phase. Our 90% of hair follicles are in the anagen phase at any given time. The inactive phase (telogen), lasts about 1 to 6 months, and about 5-15% of our hair is in this phase at any given time. All hair originates in the anagen phase, grows for a certain duration of time, and then moves into the telogen phase, which continues for approximately 100 to 120 days and then the hair falls out. If this process is accelerated, the condition is called telogen effluvium, which is the cause of hair fall after bariatric surgery in some patients.

Factors Contributing to Telogen Effluvium

Reasons to develop “telogen effluvium” after bariatric surgery are surgical stress, rapid weight loss, low appetite, and low nutrient intake specially protein, iron, zinc, biotin, and essential fatty acids. Also, patients who have poor compliance to the nutritional supplements or those who experience rapid weight loss, difficulty eating, food intolerances, especially with good quality protein sources, or do not practice healthy eating habits, may experience hair fall.

Importance of Protein Intake

Protein intake significantly decreases after bariatric surgery, especially in the first 6 months, which may lead to hair fall. Less availability of hydrochloric acid and gastric juice enzymes (pepsin and renin), limits protein digestion, so even the ingested protein is not completely utilised. A minimum of 60g per day protein is recommended to all patients after undergoing any bariatric surgery procedure, ideally, it should be 1g per Kg body weight. The protein requirements should be fulfilled through high biological value proteins, having a PDCAA score of 1.0. Patients should include eggs, chicken, fish, and other sea foods, soy products such as nuggets, granules, soy milk, and tofu; and milk and milk products to get good quality protein through diet. Protein supplements containing whey protein isolate should also be taken to complete protein needs, as small meal sizes cannot meet these requirements.

Effects of Reduced Protein Intake

Reduced protein intake causes thinning of hair, diminished hair growth, and depigmentation. Among all essential amino acids (the building blocks of proteins), deficiency of L-lysine, may contribute to hair fall. It is mainly present in fish, meat, and eggs.

Iron Deficiency and Hair Loss

Less intake and absorption of iron after surgery may contribute to hair loss, due to less availability of hydrochloric acid as stomach size has been reduced especially after gastric bypass, as the iron absorption sites get bypassed.

In females, iron deficiency is more prevalent amongst those who are of reproductive age. Highly bio-available forms of iron supplements are recommended after all bariatric procedures for better absorption and utilisation of iron, to prevent anaemia and hair fall.

Role of Biotin

Deficiency of biotin may cause depigmentation of hair and may weaken hair follicles. A multivitamin containing biotin helps prevent hair loss if taken regularly.

Importance of Zinc

Zinc also plays a crucial role in the growth and development of hair. Zinc bisglycinate is the most bio-available form of zinc and should be regularly supplemented.

Essential Fatty Acids

Essential fatty acids e.g. linoleic and linolenic acids also prevent hair fall in patients after bariatric surgery. Bypass procedures alter the digestion and absorption of dietary fats, hence essential fatty acids.

Dietary Sources of Essential Fatty Acids

Flaxseed, linseed, and olive oil are good sources of essential fatty acids and should be included in the post-bariatric surgery diet in recommended quantities to prevent deficiency.

Conclusion: Hair Fall After Bariatric Surgery

From the foregoing it can be concluded that hair fall after bariatric surgery is not a permanent feature, they do come back. The patients as advised to adhere to the dietary and nutritional supplements advice and to attend follow-up visits regularly for timely care and guidance.

Have more doubts? Schedule an appointment at Smart Cliniqs, and speak with the best bariatric surgeon in Delhi.